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NURS 407 comprenhesive examRespuestas
the Comprehensive Exam
A client with asthma receives a prescription for high blood pressure during a clinic visit. Which
prescription should the nurse anticipate the client to receive that is least likely to exacerbate asthma?
The best antihypertensive agent for clients with asthma is metoprolol (Lopressor) (C), a beta2 blocking
agent which is also cardioselective and less likely to cause bronchoconstriction. Pindolol (A) is a beta2
blocker that can cause bronchoconstriction and increase asthmatic symptoms. Although carteolol (B) is a
beta blocking agent and an effective antihypertensive agent used in managing angina, it can increase a
client's risk for bronchoconstriction due to its nonselective beta blocker action. Propranolol (D) also
blocks the beta2 receptors in the lungs, causing bronchoconstriction, and is not indicated in clients with
asthma and other obstructive pulmonary disorders.
A male client who has been taking propranolol (Inderal) for 18 months tells the nurse that the healthcare
provider discontinued the medication because his blood pressure has been normal for the past three
months. Which instruction should the nurse provide?
Although the healthcare provider discontinued the propranolol, measures to prevent rebound cardiac
excitation, such as progressively reducing the dose over one to two weeks (C), should be recommended
to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias. Abrupt cessation (A and B)
of the beta-blocking agent may precipitate tachycardia and rebound hypertension, so gradual weaning
should be recommended. (D) is not indicated.
A client who is taking clonidine (Catapres, Duraclon) reports drowsiness. Which additional assessment
should the nurse make?
How long has the client been taking the medication?
Drowsiness can occur in the early weeks of treatment with clonidine and with continued use becomes
less intense, so the length of time the client has been on the medication (A) provides information to
direct additional instruction. (B, C, and D) are not relevant.
The nurse is preparing to administer atropine, an anticholinergic, to a client who is scheduled for a
cholecystectomy. The client asks the nurse to explain the reason for the prescribed medication. What
response is best for the nurse to provide?
Decrease the risk of bradycardia during surgery.
,NURS 407 comprenhesive exam
An 80-year-old client is given morphine sulphate for postoperative pain. Which concomitant medication
should the nurse question that poses a potential development of urinary retention in this geriatric
client?
Drugs with anticholinergic properties, such as tricyclic antidepressants (C), can exacerbate urinary
retention associated with opioids in the older client. Although tricyclic antidepressants and
antihistamines with opioids can exacerbate urinary retention, the concurrent use of (A and B) with
opioids do not. Nonsteroidal antiinflammatory agents (D) can increase the risk for bleeding, but do not
increase urinary retention with opioids (D).
A client with osteoarthritis is given a new prescription for a nonsteroidal antiinflammatory drug (NSAID).
The client asks the nurse, "How is this medication different from the acetaminophen I have been
taking?" Which information about the therapeutic action of NSAIDs should the nurse provide?
Provide antiinflammatory response.
A client with cancer has a history of alcohol abuse and is taking acetaminophen (Tylenol) for pain. Which
organ function is most important for the nurse to monitor?
Acetaminophen and alcohol are both metabolized in the liver. This places the client at risk for
hepatotoxicity, so monitoring liver (A) function is the most important assessment because the
combination of acetaminophen and alcohol, even in moderate amounts, can cause potentially fatal liver
damage. Other non-narcotic analgesics, such as n onsteroidal anti-inflammatory drugs (NSAIDs), are
more likely to promote adverse renal effects (B). Acetaminophen does not place the client at risk for
toxic reactions related to (C or D).
The nurse obtains a heart rate of 92 and a blood pressure of 110/76 prior to administering a scheduled
dose of verapamil (Calan) for a client with atrial flutter. Which action should the nurse implement?
Administer the dose as prescribed.
Verapamil slows sinoatrial (SA) nodal automaticity, delays atrioventricular (AV) nodal conduction, which
slows the ventricular rate, and is used to treat atrial flutter, so (A) should be implemented, based on the
client's heart rate and blood pressure. (B and C) are not indicated. (D) delays the administration of the
scheduled dose.
A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and influenza. Which
categories of illness should the nurse develop goals for the client's plan of care?
One chronic and one acute illness.
, NURS 407 comprenhesive exam
Following an emergency Cesarean delivery, the nurse encourages the new mother to breastfeed her
newborn. The client asks why she should breastfeed now. Which information should the nurse provide?
Stimulate contraction of the uterus.
Which intervention should the nurse include in the plan of care for a female client with severe
postpartum depression who is admitted to the inpatient psychiatric unit?
Supervised and guided visits with infant.
A 16-year-old male client is admitted to the hospital after falling off a bike and sustaining a fractured
bone. The healthcare provider explains the surgery needed to immobilize the fracture. Which action
should be implemented to obtain a valid informed consent?
The client is a minor and cannot legally sign his own consent unless he is an emancipated minor, so the
consent should be obtained from the guardian for this client, which is the custodial parent (B). (A) is not
a legal option. A stepparent is not a legal guardian for a minor unless the child has been adopted by the
stepparent (C). The non-custodial parent does not need to co-sign this form (D).
During a client assessment, the client says, "I can't walk very well." Which action should the nurse
implement first?
Identify the problem.
The nurse identifies a client's needs and formulates the nursing problem of, "Imbalanced nutrition: less
than body requirements, related to mental impairment and decreased intake, as evidenced by increasing
confusion and weight loss of more than 30 pounds over the last 6 months." Which short-term goal is
best for this client?
Eat 50% of six small meals each day by the end of one week.
A male client is angry and is leaving the hospital against medical advice (AMA). The client demands to
take his chart with him and states the chart is "his" and he doesn' t want any more contact with the
hospital. How should the nurse respond?
The chart is the property of the facility, but the client has a legal right to the information in it, even if he
is leaving AMA, so a copy of the record (D) should be provided. The client does not lose his legal rights to
his medical record if he leaves AMA (A). The medical record is confidential, but the hospital protects the
client's privacy by not allowing unauthorized access to the record, so the hospital may provide the client
with a copy (B). The hospital must maintain records of the care provided and should not release the
original record (C).
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